THE PATH TO SUCCESS: UNDERSTANDING THE SIGNIFICANCE

OF SAGITTAL CONDYLAR PATH AND HORIZONTAL INCISAL PATH

Authors: Dr. Krishna Prasad, Dr. B. Rajendra Prasad , Dr. Lobo Nikhil Jason.
Abstract:
A Prosthodontics goal in the recording mandibular movements is to permit an understanding of the effect of various
factors controlling mandibular motion and to permit the transfer of these factors to an articulator which enhances
visualization of the effect of individual factors in the patients absence. The importance of condylar motion as a
function of mandibular movements cannot be understated. The condyles move as guided by various guiding
elements, they are the morphology of the articular fossa adjacent to the condyle and the anterior guidance as
provided by the anterior teeth
The treatment plan of the patient is influenced by various characteristics of the patient, for instance the presence of
teeth, condition of the soft tissue, the condition of bone. These characteristics can be altered within limits to provide
for a more favourable treatment. However they are essentially fixed traits which must be taken into account to ensure
a harmonious prosthesis. Other essential characteristics one cannot avoid are the Sagittal Condylar Path and the
Horizontal Incisal Path of the patient.
This article explores the various concepts and controversies related to the Sagittal Condylar path and Horizontal
Incisal path and describe the methods related to recording them.
Introduction:
The purpose of recording mandibular movements is to understand the effect of various factors controlling mandibular
motion. An essential factor in mandibular motion is the movement of the condyle. The condyles move as guided by
various guiding elements, they are the morphology of the articular fossa adjacent to the condyle and the anterior
guidance as provided by the anterior teeth. 1,2
The possibility of a correlation existing between the path followed by the advancing condyle , the morphology of the
articular surface and their corresponding effects on occlusal surfaces of teeth has been investigated extensively. 3
Balkwill was the first to describe jaw movements as early as 1866. Since then Gysi, Hanau, McCollum and numerous
others have all investigated mandibular movements and further emphasized the importance of understanding these
movements and recording them to obtain harmonious restorations. 4
When the patients casts are mounted on an articulator by using a facebow transfer, the maxillary cast is oriented in
the articulator in the same relationship as the maxilla is to the base of the skull and thus the hinge axis of the patient
is transferred to the articulator. Further transfer of the patients condylar guidance values to the articulator will permit
reproduction of patient movements in an articulator with a fairly acceptable degree of accuracy. 5
When considering the treatment plan of the patient we consider various characteristics of the patient for instance the
presence of teeth, condition of the soft tissue, the condition of bone, these are fixed characteristics which the patient
presents with which affect our treatment. Other essential characteristics one cannot avoid are the Sagittal Condylar
Path and the Horizontal Incisal Path of the patient.
Mandibular Movements, Condylar and Incisal Paths :
Mandibular movement occurs as a series of complex interrelated rotational and transitional activity. It occurs due to
simultaneous activity of both Temporomandibular joints. Mandibular movement about a horizontal axis causes hinge
like opening and closing motion, this movement is said to occur at centric relation. 4 Although recent studies refute the
possibility of pure hinge rotation, the concept of rotation at centric relation continues to be a reliable reference in
recording the relationship of the mandible to the maxilla. 6,7
When the mandible moves forwards the condlye and its assembly move anteriorly and a transalatory motion results.
The guidance offered by the articular eminence of the mandibular fossa is dependent on the steepness of the
articular fossa and is called the Condylar Guidance. 2,8
The articular surfaces of the temporomandibular joints provide guidance for the posterior portion of the mandible,
whereas guidance to the anterior portion of the mandible is provided by the presence of tooth contact, called Anterior
Guidance. While most literature describes anterior guidance as the guidance to mandibular motion due to incisal
edges of the mandibular teeth contacting the lingual surface of the maxillary teeth, in reality this is ideal anterior

guidance. Anterior Guidance as a rule can occur on any teeth not necessarily the anterior teeth. The term simply
implies guidance to mandibular motion occurring anterior to the posterior controlling factors or the TMJs. 9,10
Various methods and techniques have been described to record Mandibular motion. These techniques essentially
involve recording the fixed characteristics of the patient which effect the movements, which is the Sagittal Condylar
path and the Horizontal incisal path.
The Condylar path is described by the Glossory of Prosthodontic Terminology as that path traveled by the mandibular
condyle in the temporomandibular joint during various mandibular movements. 11
In Clinical Practice commonly used methods to determine Sagittal path inclination are

Intra-oral records

Wear Facets of the teeth

Graphic methods

Roentgenographic methods

Mandibular Motion Analysers

Intraoral Records- Christensen (1905) advocated utilization of wax registration method to set the condylar
guidance values directly on an articulator. Various materials may be utilized such as wax, wax wafers reinforced with
0.05 mm aluminum foil, modeling compound, zinc oxide eugenol paste, polyether impression material. The patients
are asked to protrude to a predetermined distance of 6mm and the record is made in the registration material.
However studies have demonstrated lower values for condylar guidance obtained using the intraoral registration
method. Another important limitation of this method irrespective of the material used is that saggital condylar
guidance values are altered depending on the amount of protrusion, however the intraoral-record gives only a value
for only one point on the path.12,13,14

Wear Facets of teeth the condylar inclination may be set by matching of the wear facets of opposing
canines and contra-lateral molars in a laterotrusive movement. This technique may be untilised when a protrusive
record has not been made or simply as a verification of the accuracy of the protrusive registration. However
recommendations for the use of this technique include setting the value at 5 to 10 degrees higher to accommodate
the wearing of the teeth. 15.

Graphic methods this method employs use of graphic recordings of condylar inclination during protrusion.
Tracing devices used maybe either extraoral or pantographic tracing. A mandibular facebow and intraoral bearing
plate are utilized which help facilitate the procedure while the subject performs protrusive movements. The patients
hinge axis is locate initially and the patient is asked to perform protrusive movements to produce tracing on graph

paper situated anterior to the ear. An important prerequisite is determination of the reference plane to facilitate
measurement of the condylar path. Tangents are drawn to the paths is protrusion and the values are calculated either
by measurement directly or by using mathethical methods or the B-Spline curve fitting technique. However the
literature indicates that errors may occur while using this technique mainly due to difficulties in drawing the tangent to
the condylar path which is curved rather than due to the procedure of recording.13,14,16,17,18

Roentgenographic methods- Most techniques of recording the sagital condylar path utilize a record which
is a composite of the path of both codyles. Numerous factors can affect the consistency of this procedure.
Radiographic methods invole conventional TMJ imaging techniques or the use of panoramic radiography .The
technique involves tracing of the condylar path on the radiograph and direct measurement of the angle formed
between the condylar path or slope of the articular fossa and a reference plane. The roentgenographic methods can
identify the form and characteristics of the TMJs. The condylar path angle is set on the articulator to coincide with the
angle determined on the radiograph. The determined values may be checked using an intra oral registration
technique8,19

Mandibular Motion Analysers- Mandibular motion analysers can be used to record Immediate Side Shift
and mandibular protrusive movements . The analysers produce more consistent records than intra-oral registration
techniques. However variations in the values obtained by using analysers of different manufacturers. 2,12

What is an essential factor to be considered in the recording of condylar path inclination is the cranial plane
or the reference plane being utilized. Gysi measured the value in relation to his Prosthetic Plane. Whereas
alternatively present day articulators may utilize the Frankfort horizontal plane, Midfacial horizontal plane or the axis
orbital plane as a reference plane. However studies demonstrate that use of the Orbitale or Inferior annular notch as
a third point of reference in facebow transfer results in values which are closest to the radiographic determined
values. 20,21

Replacement or restoration of missing and associated structures is an integral part of rehabilitation in prosthodontics.
The subject of the kind of tooth form to be provided during restoration has been the topic of much debate. Certain
authors believe that almost any tooth form is adequate and that the condylar path is not fixed and that it is greatly
influenced by the Incisal Path. Other authors believe no relation exists between the condylar and incisal path and that

once the anterior guidance and occlusal plane is determined only a single tooth form is appropriate for a patient. 22To
understand the controversy the importance of Condylar guidance and anterior guidance/ Incisal Path must be
understood.

As the mandible protrudes the condyles descent along the articular fossa . The extent to which this descent occurs is
dependent upon the steepness of the articular eminence. The greater the descent the more the condyle moves
downwards and thus greater separation between the mandible and mandibular teeth occurs. Since the separation
between the teeth is increased the cusps of the teeth can be steeper while still producing the necessary disocclusion
which is desirable in the natural dentition. Thus a steeper condylar path allows for steeper cuspal inclines on the
teeth. 23

The incisal path is a function of the relationship between the anterior teeth. The relationship of the maxillary and
mandibular anteriors in normal patient is characterised by horizontal and vertical overlap of the teeth. Greater the
vertical overlap greater steeper is the incisal path resulting in steeper cuspal inclines. When the horizontal overlap is
increased the mandible assumes a more horizontal pattern of movement and lesser is the guidance offered by the
anterior teeth resulting in shallower cuspal anatomy. Hence an accurate determination of the condylar and incisal
path is essential to ensure restorations having cuspal anatomy that is harmonious with the controlling factors of
mandibuar motion. 24,25

Discussion:
The importance of the Controlling factors in mandibular movements forms the basis for good prosthetic rehabilitation.
Prosthetic rehabilitation sometime necessitates development of a stable anterior guidance path, which would, allow
symmetric and favourable mandibular kinematics in harmony with the neuromuscular movements. A functional
occlusion provides for stable mandibular function without excessively stressing the components of the masticatory
system. Hence it aids in reduction of applied forces to the dentition while providing optimal function. 26

The act of creating a steeper anterior guidance to allow for favourable disclusion in the posteriors has in recent years
gained popularity to the extent that it is often called as anterior control. While in protrusive movements the anteriors
disocclude the posterior teeth and in lateral movement the canine have a role in creating posterior disocclusion. This
philosophy forms the basis for mutually protected occlusion and canine protected occlusion. To provide for this type of
occlusion there must be an agreement between the anterior and posterior controlling factors of mandibular

movement. 26

A proponent of this concept is Dawson who believes that anterior guidance and condylar guidance are closely
related. He does not believe that the posterior teeth should be allowed to share the load in eccentric movements. His
belief is that even anterior teeth weakened by periodontal considerations, it is better for them to accept the load in
eccentric movements as they actually are reducing the overall load through reduction in elevator muscle activity. 27

When comparing occlusal schemes one understands that during a chewing stroke, in canine guidance there is a
significant decrease in horizontal forces by limiting posterior teeth contacting their opposing fossa and inclines during
lateral movements. This is provided for by the steeper inclines of the canines. This results in a more sagittal chewing
stroke when viewed from the front. 28

In group function the first contact does not occur between the supporting cusp and opposing fossa, but instead occur
at a more lateral position followed by a slide to centric occlusion. This will exert some horizontal forces. 28

An obvious conclusion must be that with greater horizontal forces present in group function the teeth would exhibit
greater mobility. However, in a study by O'leary, Shanley, and Drake 29 they found this was not the case. They found,
teeth in a group function occlusion had less mobility than teeth in Canine protected scheme. However in contrast to
this a study by Siebert30 found that canine protected occlusion limits tooth mobility.

Although the literature does not clearly suggest a particular occlusal scheme as better than the other the relation
between the incisal and condylar pathways as a factor in rehabilitating occlusion is emphasized.

Schuyler 31 believes that the incisal guidance should equal or be greater than the guidance offered by the
temporomandibular joints in its control over the functional occlusion of the dentition.

Kohno 9 believes that the incisal path should equal the condylar path. When rotation of the condyle occurs; however,
the incisal path may be increased, but not more than 25 degrees.

In a study by Zoghby et al 26 they concluded that the incisal path should greater than all other guidance paths. The
inclinations must present a harmonious reduction from central incisors proceeding to the canines. They believe an

insical inclination path of 10 degrees superior to the condylar inclination path ensures predominance of the incisal
guidance in mandibular kinetics.

Another important factor while considering mandibular movements is the occurrence of Bennet Side shift. Patients
having excessive Bennett movement with low anterior guidance present the prosthodontist with the greatest
challenge to occlusal rehabilitation. The reason being the cusp movement pathways during mandibular eccentric
movements are very shallow. Increasing the anterior guidance in these patients produces only a slight change in the
lateral pathways. On the other hand in patients exhibiting little Bennet shift ,the anterior guidance along with the
condylar guidance plays a role in producing disocclusion between the posterior teeth in eccentric movements. 25

It is a popular belief that the condylar path must be duplicated in the palatal surfaces of the maxillary anterior teeth to
permit guidance to the mandibular teeth along the same path. However what should be considered is that Condylar
paths are independent of the anterior guidance, and there exists no benefit in making the anterior guidance duplicate
condylar guidance. Authors often fail to recognize condylar rotation is often accompanied by translation during
mandibular motion .This allows the anterior portion of the mandible to have a different path without affecting the
condylar path. Anterior guidance cannot be decided by simple visualization on an articulator irrespective of how
accurately the condylar guidance path is duplicated. It is independent and must be determined in the patient where
the factors affecting anterior tooth position can be visualized in function.

While this article focuses essentially on the importance of factors affecting occlusion in the natural dentition what
merits special mention is the importance of the sagital condylar path and horizontal incisal path in developing a
balanced occlusal scheme in complete denture prosthodontics. Balanced occlusion in complete dentures is obtained
by providing bilateral simultaneous contacts on both maxilla and mandible during eccentric mandibular movements
within a functional range.

The cuspal inclines of the teeth must harmonize with the factors influencing mandibluar motion. That is the teeth
should posses an anatomy so as to permit the cusps to glide over each during both protrusive movements as well as
horizontal movements. The nature of these contacts must be smooth and bilateral to prevent undesirable dislodging
forces from acting on the prosthesis. In contrast to the natural dentition disocclusion in the posteriors during eccentric
movements is considered undesirable and unnecessary and hence is eliminated by placing specific teeth in specific
positions so as to provide for stable contacts away from the centric position and enhance stability of the prosthesis.

While authors may have mixed opinions about the method of developing balanced occlusion, there seems to be a
consensus on the importance of the sagital and incisal path in this occlusal scheme.

Conclusion:
An understanding of the Sagittal Condylar Path and Horizontal Incisal Path is the cornerstone to good prosthetic
rehabilitation. These factors have been extensively studied and the literature has varying opinions regarding the
concepts related to them and the accuracy of the methods available to record them. However although the literature
does not clearly describe one method as absolutely accurate, what is undeniable is the individual factors importance
in the fabrication of restorations which will be harmonious with the stomatognatic system.

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